Buchner Sara H, Malta Kiana, Wang Shiyu, Guevara Adriana, Glickman Cynthia, Hookim Kim, Traisak Pamela, Karpoff Marissa, Feinstein David, Eid Hala
Orthopedics, Cooper Medical School of Rowan University, Camden, USA.
Psychiatry, University of Massachusetts Chan Medical School, Worcester, USA.
Cureus. 2024 Nov 21;16(11):e74140. doi: 10.7759/cureus.74140. eCollection 2024 Nov.
Drug-induced lupus erythematosus (DILE) is an autoimmune reaction that results in symptoms of polyarthralgia, fever, and cutaneous lesions and other manifestations. Several drugs have been documented to cause this disease, including procainamide, isoniazid, methyldopa, penicillamine, and hydralazine. Systemic lupus erythematosus (SLE) manifestations often occur after the patient has been taking the drug without complications for months to years. Hydralazine, an oral antihypertensive drug, is a well-known cause of DILE; however, clinical presentation is generally limited to classic SLE symptoms such as malar or discoid rash and polyarthralgia. In this case, we will discuss a 75-year-old female patient with actively bleeding oral, nasal, and conjunctival ulcers of unknown origin, eventually found to have bullous lupus erythematosus while on hydralazine for several years. Bullous lupus erythematosus is a rare cutaneous manifestation of SLE that presents with blister-type lesions in patients with a history of SLE. Histologically, bullous lupus erythematosus is characterized by marked epidermal and dermal inflammation, and an inflammatory infiltrate that consists primarily of neutrophils at the base of the bullae. Although hydralazine has been implicated in DILE, it is very rarely noted to have a bullous lupus erythematosus presentation. Given the acuity of patient's presentation and resolution with cessation of hydralazine, it was concluded that hydralazine was the main contributing factor for this patient's multiple hemorrhagic bullous lupus erythematosus lesions.
药物性红斑狼疮（DILE）是一种自身免疫反应，可导致多关节痛、发热、皮肤病变及其他表现。已有多种药物被记录可引发此病，包括普鲁卡因胺、异烟肼、甲基多巴、青霉胺和肼屈嗪。系统性红斑狼疮（SLE）的表现通常在患者服用该药物数月至数年且无并发症后出现。肼屈嗪是一种口服降压药，是导致DILE的常见原因；然而，临床表现一般局限于典型的SLE症状，如蝶形或盘状皮疹以及多关节痛。在本病例中，我们将讨论一名75岁女性患者，其口腔、鼻腔和结膜出现不明原因的活动性出血性溃疡，最终在服用肼屈嗪数年期间被诊断为大疱性红斑狼疮。大疱性红斑狼疮是SLE一种罕见的皮肤表现，在有SLE病史的患者中出现水疱样病变。组织学上，大疱性红斑狼疮的特征是明显的表皮和真皮炎症，以及主要由位于水疱底部的中性粒细胞组成的炎性浸润。虽然肼屈嗪与DILE有关，但很少有大疱性红斑狼疮的表现。鉴于患者表现的急性发作以及停用肼屈嗪后症状缓解，得出结论：肼屈嗪是该患者多发性出血性大疱性红斑狼疮病变的主要促成因素。
